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F Schmidlin

Publications and source records attributed to F Schmidlin.

34 records · Page 2Linked to original sources
PubMed1998

Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 2: Gastrointestinal tract and retroperitoneal organs.

Computed tomography plays an important role in the detection and management of blunt visceral injuries in adults. Current standard examination techniques enable detection of the majority of perforating or devascularizing bowel injuries, although diagnostic findings are often subtle and meticulous inspection is required. Computed tomography may demonstrate pancreatic contusions and lacerations and help in distinguishing minor traumatic lesions without involvement of the pancreatic duct (organ injury scale, grades I and II) from deep lacerations with ductal involvement (grades III and V). Computed tomography enables distinguishing renal contusions and minor cortical lacerations that can usually be managed conservatively (injuries of grades I-III) from corticomedullary lacerations and injuries of the major renal vessels (grades IV and V) that have a less favorable prognosis and more commonly require surgical repair. In addition, CT is well suited for the detection of active renal hemorrhage and guidance of transcatheter embolization treatment and delineation of preexisting benign or malignant pathologies that may predispose to posttraumatic hemorrhage. The radiologist's awareness of the diagnostic CT findings of abdominal visceral injuries as well as their clinical and surgical implications are important prerequisites for optimal patient management.

Abdominal Injuries↗
PubMed1998

Effect of WIN 64338, a B2 bradykinin receptor antagonist on guinea-pig tracheal smooth muscle cells in culture.

This study investigated the effect of the non-peptidic B2 bradykinin (BK) receptor antagonist WIN 64338 on BK binding and BK-induced inositol phosphate formation on guinea-pig tracheal smooth muscle cells in culture. The presence of specific and saturable binding sites for BK was demonstrated using [3H]BK. Scatchard analysis indicates a single population of binding sites for [3H]BK with a maximal density (Bmax) of 245.4 +/- 71 fmol/mg of protein and an equilibrium dissociation constant (Kd) of 87.7 +/- 0.12 pM. The order of potency of] B2 BK receptor ligands was Hoe 140 = NPC 17731 > BK > WIN 64338 > D- Arg0[Hyp3, D-Phe7]-BK > > des-Arg9-BK, while B1 BK receptor antagonist, des-Arg9-[Leu8]-BK, was without effect on [3H]BK binding. These results demonstrate the presence of B2 Bk receptors on cultured tracheal smooth muscle cells. The cells were stimulated by BK, and inositol phosphate formation was determined by anion exchange chromatography. The stimulating effect of BK on inositol phosphate formation was concentration dependent (1 nM to 10 microM). The B1 BK agonist des-Arg9-BK did not induce inositol phosphate formation. The order of potency of B2 antagonists to inhibit BK-induced inositol phosphate formation was Hoe 140 = NPC 17731 > WIN 64338 > D-Arg0[Hyp3, D-Phe7]-BK. This study demonstrates that WIN 64338 is able to displace [3H]BK binding and to inhibit B2-BK-induced inositol phosphate formation on cultured guinea-pig tracheal smooth muscle cells.

Adrenergic beta-Antagonists↗
PubMed1998

Up- and down-regulation by glucocorticoids of the constitutive expression of the mast cell growth factor stem cell factor by human lung fibroblasts in culture.

Stem cell factor (SCF) is a major mast cell growth factor that promotes differentiation and chemotaxis of mast cells and inhibits their apoptosis. SCF therefore may be involved in diseases associated with an increased number of tissue mast cells such as asthma, for which the major treatment is glucocorticoids. In this study, we evaluated the effect of the glucocorticoid budesonide on the constitutive expression of SCF by human lung fibroblasts in primary culture. Budesonide (0.1 microM) induced a time-dependent biphasic effect on SCF mRNA and protein production. A short treatment (2.5-10 hr) induced an inhibition of SCF protein accumulation (-58% at 2.5 hr) and mRNA expression (-69% at 2.5 hr), associated with an accelerated decay of SCF mRNA and with a decrease in SCF gene transcription observed by nuclear run-on assay. Longer treatment (24-72 hr) led to increases in SCF protein accumulation (+64% at 48 hr) and mRNA expression (+125% at 24 hr) as a consequence of transcriptional activation. Similar effects of a decrease followed by an increase in SCF production were observed using another glucocorticoid, dexamethasone. Overall, our results show that glucocorticoids potently regulate SCF expression in human lung fibroblasts, successively decreasing and increasing SCF mRNA levels according to treatment duration. Such time-dependent modulation of SCF levels may explain some current discrepant findings about the effects of glucocorticoids on SCF production and may have functional consequences during glucocorticoid treatment, such as asthma therapy.

Budesonide↗
PubMed1998

Interleukin-1beta induces bradykinin B2 receptor gene expression through a prostanoid cyclic AMP-dependent pathway in human bronchial smooth muscle cells.

We investigated the hypothesis that inflammatory mediators such as interleukin-1beta (IL-1beta) might be responsible for the hyperreactivity of asthmatic patients to bradykinin. In cultured human bronchial smooth muscle cells, IL-1beta elicited a rapid and transient increase in the density of bradykinin B2 receptors without affecting their affinity for ligands. The increase in B2 receptors was correlated to an enhancement of inositol phosphate formation elicited by bradykinin, indicating its relevance to the contractile response of smooth muscle cells to bradykinin. The increase in receptor density was related to an increase in B2 receptor mRNA level corresponding to a 5-fold enhancement of the transcriptional rate and to a lengthened half-life of mRNA. These effects of IL-1beta were largely inhibited by indomethacin, suggesting the involvement of a prostanoid pathway in IL-1beta transduction process. An increase in prostaglandin E2 levels preceded the mRNA increase, confirming this involvement. Moreover, IL-1beta and prostaglandin E2 led to cAMP formation. We propose this predominant transduction pathway of IL-1beta to stimulate the transcription of the bradykinin B2 gene in human bronchial smooth muscle cells as a major mechanism involved in the hyperresponsiveness of asthmatic patients to bradykinin.

Bronchi↗
PubMed1998

Biomechanical analysis and clinical treatment of blunt renal trauma.

The treatment of renal trauma is evolving and increasingly focusing on the nonoperative and expectant management. In this review the ongoing controversy concerning the diagnosis and management of major blunt renal trauma shall be revisited. The contribution also includes a biomechanical approach for analyzing the renal injury mechanisms using a computer-simulated model of the kidney. In this connection, results of the modelling and simulations of the kidney subjected to the external forces shall be presented. Based on these findings a bending mechanism is postulated that may be responsible for renal injuries. Finally, the role of injury biomechanics research in the clinical management of trauma patients as well as in the area of injury prevention is discussed.

Abdominal Injuries↗
PubMed1997

Clinical evaluation of a method for detecting superficial surgical transitional cell carcinoma of the bladder by light-induced fluorescence of protoporphyrin IX following the topical application of 5-aminolevulinic acid: preliminary results.

BACKGROUND AND OBJECTIVE: In bladder cancer, conventional white light endoscopic examination of the bladder does not provide adequate information about the presence of "flat" urothelial lesions such as carcinoma in situ. In the present investigation, we examine a new technique for the photodetection of such lesions by the imaging of protoporphyrin IX (PpIX) fluorescence following topical application of 5-aminolevulinic acid (ALA). STUDY DESIGN/MATERIALS AND METHODS: Several hours after bladder instillation of an aqueous solution of ALA in 34 patients, a Krypton ion laser or a filtered Xenon arc-lamp was used to excite PpIX fluorescence. Tissue samples for histological analysis were taken while observing the bladder wall either by means of a video camera, or by direct endoscopic observation. RESULTS: A good correlation was found between the PpIX fluorescence and the histopathological diagnosis. On a total of 215 biopsies, 143 in fluorescent and 72 in nonfluorescent areas, all visible tumors on white light cytoscopy appeared in a bright red fluorescence with the photodetection technique. In addition, this method permitted to discover 47 unsuspected carcinomatous lesions on white light observation, among which 40% were carcinoma in situ. CONCLUSION: PpIX fluorescence induced by instillation into the bladder of 5-ALA is an efficient method of mapping the mucosa in bladder carcinoma.

Administration, Cutaneous↗
PubMed1997

Clinical assessment of fluorescence cytoscopy during transurethral bladder resection in superficial bladder cancer.

The prognosis of superficial bladder cancer in terms of recurrence and disease progression is related to bladder tumor multiplicity and the presence of concomitant "plane" tumors such as high-grade dysplasia and carcinoma in situ. This study in 33 patients aimed to demonstrate the role of fluorescence cystoscopy in transurethral resection of superficial bladder cancer. The method is based on the detection of protoporphyrin-IX-induced fluorescence in urothelial cancer cells by topical administration of 5-aminolevulinic acid. The sensitivity and the specificity of this procedure on apparently normal mucosa in superficial bladder cancer are estimated to be 82.9% and 81.3%, respectively. Thus, fluorescence cytoscopy is a simple and reliable method for mapping the bladder mucosa, especially in the case of multifocal bladder disease, and it facilitates the screening of occult dysplasia.

Adult↗
PubMed1997

Oxybutynin in the treatment of early detrusor instability after transurethral resection of the prostate.

OBJECTIVE: To evaluate the symptomatic and urodynamic effects of oxybutynin in the control of irritative micturitional symptoms during the first week after transurethral resection of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Fifty-three patients (median age 67 years, interquartile range 62-72) were included prospectively in a double-blind placebo-controlled study. Pre-operatively, uroflowmetry and cystometrography (CMG) were performed, and the post-void residual volume (PVR) measured; symptoms were rated according to the Boyarski score. CMG was repeated on the first post-operative day and medication was started on the third day. Before withdrawing the catheter on the fifth day. CMG was repeated. Three days later, symptoms were evaluated according to the Boyarski score and uroflowmetry and the estimate of PVR reassessed. RESULTS: In comparison with placebo, oxybutynin significantly decreased frequency, urgency and detrusor pressure at first sensation of filling. However, oxybutynin did not lower the rate of pre-operative detrusor instability and exerted no effect on the maximal capacity of the bladder and corresponding detrusor pressure. Dryness of mouth was reported in 13% and 65% of patients receiving placebo and oxybutynin, respectively. CONCLUSION: Oxybutynin alleviates early irritative symptoms after transurethral resection of BPH, without consistently modifying bladder urodynamics.

Aged↗
PubMed1997

Safety and efficiency of laparoscopic varicocelectomy in one hundred consecutive cases.

The purpose of this study is to report the safety and efficiency of laparoscopic varicocelectomy in 100 consecutive patients operated at a single teaching institution. There were three indications: (1) infertility associated with oligo-astheno-teratospermia (n = 52); (2) chronic dragging sensation of the left testicle (n = 42), and (3) incidental finding of a large varicocele in young adolescents (n = 6). In group 1, the postoperative pregnancy rate was 47% and sperm quantity, concentration and mobility were significantly increased. The efficiency in pain control and clinical outcome amounted to 80 and 100% in groups 2 and 3, respectively. Complications were few and minor. There was no intraperitoneal organ or major vessel injury. The mean length of hospital stay (0.9 days) and median total recovery time (5 days) were remarkably short. In conclusion, laparoscopic varicocelectomy is a safe procedure. It is as efficient as open spermatic vein ligation, and provides the patient with a short hospital stay and quick full recovery.

Adult↗
PubMed1997

[Vaporization of urethral stenosis using the KTP 532 laser].

The authors treated 16 patients presenting with a total of 20 anterior urethral strictures using the KTP 16 Laser. The aetiology was iatrogenic in 50% of cases, infectious in 20% of cases, traumatic in 20% of cases and unknown in 10% of cases. The stricture was situated in the bulbous urethra (80%), membranous urethra (10%) or penil urethra (10%). Laser vaporization of the urethral stricture was performed over the entire circumference of the urethra when necessary, followed by bladder drainage by urethral catheter for 24 hours. All patients were prospectively reviewed at 3 weeks, 3 months and 6 months (clinical symptoms, uroflowmetry, cystourethrography). A complete symptom and urodynamic success was obtained in 13 patients (81%) at 3 and 6 months. The stricture recurred in 4 patients, but only three of them (19%) required treatment (reoperation of repeat dilatations). The mean maximum flow rate increased from 6 mL/s to 20 mL/s at 3 months and was maintained at 19 mL/s at 6 months. No intraoperative or postoperative complications were observed. In conclusion, our results confirm that KTP 532 laser urethral strictures is a reliable and effective method in the medium term. These good results also suggest an advantage in terms of the recurrence rate in comparison with internal urethrotomy. However, our series needs to be evaluated with a longer follow-up and prospective, randomized trials comparing the two methods need to be conducted.

Adult↗
PubMed1997

[The clinical value of fluorescence cystoscopy in the detection of superficial transitional epithelial cell carcinoma of the bladder].

The prognosis of superficial bladder cancer in terms of local recurrence and transformation into invasive cancer is related to the multiplicity of tumor sites and the concomitant presence of "flat" tumours, such as dysplasia and carcinoma in situ. This study of 51 patients emphasizes the value of fluorescence cystoscopy in the early detection of superficial transitional cell carcinomas. This method is based on induction of fluorescence in carcinomatous sites which selectively accumulate an endogenous photosensitizer, protoporphyrin IX, in response to intravesical administration of its precursor, 5-aminolevulinic acid. The sensitivity of the method in the present series was close to 93%. Fluorescence cystoscopy is a simple and reliable method to map the bladder mucosa looking for areas of dysplasia and carcinoma in situ.

Administration, Intravesical↗
PubMed1994

[Treatment of impotence with suction pumps].

Suction erectors are not a new idea in the range of treatments available for impotence. However, urologists have been interested in them for less than 10 years, although they have been available in the U.S.A. since 1974. We describe the results of a series of 32 patients with a mean age of 54 years treated by a Erecaid Osbon pump. 84% of them suffered from organic impotence. The success rate was 66% with a mean follow-up of 6.6 months. No serious adverse effect was observed. However, minor problems were reported by 75% of users: inhibition of ejaculation, pain, cold or pivoting penis. This is a safe and effective treatment, provided patients are correctly selected, as cases of partial and psychogenic impotence have a much lower success rate: failure rate in the case of organic impotence: 30%, psychogenic: 40%, total: 26%, partial: 56%. The better results are obtained in patients suffering from organic impotence, in a stable couple and whose partners participate in the therapeutic choice. The literature is reviewed and discussed.

Adult↗
PubMed1993

[The swiss experience of ileo-anal anastomosis with reservoir (AIA). Complications and functional results].

Two hundred and thirteen ileal pouch-anal anastomoses were performed in Switzerland from August 1980 to December 1991, 174 (82%) of them in 7 centres. One hundred and sixty four patients (77%) were operated for ulcerative colitis, 47 (22%) for familial polyposis and 2 others (1%) for another reason. A J pouch was created in 176 cases (83%), an S pouch in 35 cases (16%) and a W pouch in 2 cases (1%). Detailed results were available for 157 (74%) of the 213 operated patients: 81 females (52%) and 76 males (48%) with a mean age of 33.5 years (10-65). One hundred and twenty seven patients (81%) were operated for ulcerative colitis, including 42 as an emergency, and 30 (19%) for familial polyposis. One hundred patients (64%) developed complications which required one or several reoperations (laparotomy and/or perineal operation) in 64 cases (41%). Pouchitis was the most frequent complication (19%). Small bowel obstruction and pelvic abscess secondary to an anastomotic leak were the complications most frequently requiring second laparotomy with an incidence of 13% and 11%, respectively. The mean number of stools per 24 hours was 5.5 (2 to 14). 27% of patients passed one or several nocturnal stools every night, 27% occasionally, and 46% never. Occasional faecal incontinence was reported by 8 patients (6%) and 4 patients (3%) reported uncontrollable urgency. Nine patients retained a permanent ileostomy (failure rate: 6%).

Adenomatous Polyposis Coli↗
PubMedDate not supplied

Long-term results after surgical management of chronic pancreatitis.

BACKGROUND/AIMS: Long-term outcome in surgery for chronic pancreatitis remains relatively unknown. METHODOLOGY: Between 1963 and 1993, we performed 123 pancreatic resections and 35 drainage procedures for severe chronic pancreatitis. We reviewed 131 patients with a mean follow-up of 48 months (4 months to 18 years). RESULTS: Actual 10-year survival was 82% for nonalcoholic patients and 51% for alcoholic pancreatitis. Pain was successfully treated in 71% with pancreatic resection and in 42% with drainage procedures (p<0.01). Although post-operative diabetes mellitus occurred in 56% of patients after pancreatic resection, long-term nutritional status was similar after pancreatic resection and drainage procedures. Weight gain could be observed in 75 patients (47%) and quality-of-life was good to excellent in 97 patients (74%). CONCLUSIONS: In conclusion, long-term survival was mainly conditioned by the etiology of the disease. Pancreatic resections were more successful in treating intractable pain than drainage and required fewer re-interventions. As presumed, resections were associated with a higher rate of diabetes mellitus, but this, however, had no impact on long-term nutritional status and quality-of-life.

Adult↗